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Health Benefit Plans: Individual and Group
Law
Oregon Revised Statutes
Financial Institutions, Insurance
Health Benefit Plans: Individual and Group
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Section
743B.001
Definitions.
Section
743B.003
Purposes.
Section
743B.005
Definitions.
Section
743B.010
Issuance of group health benefit plan to affiliated group of employers; determination of number of employees for purpose of determining eligibility as small employer.
Section
743B.011
Group health benefit plans subject to provisions of specified laws; exemptions.
Section
743B.012
Requirement to offer all health benefit plans to small employers; offering of plan by carriers; exceptions.
Section
743B.013
Requirements for small employer health benefit plans.
Section
743B.020
Eligible employees and small employers; rules.
Section
743B.100
Department’s authority to regulate market.
Section
743B.102
Certifications and disclosure of coverage.
Section
743B.103
Use of health-related information.
Section
743B.104
Coverage in group health benefit plans; consideration of prospective enrollee health status restricted; effect of discontinuing offer of plans; exceptions; coverage by multiple employer welfare arrangements.
Section
743B.105
Requirements for group health benefit plans other than small employer plans.
Section
743B.109
Short term health insurance policies; rules.
Section
743B.110
Implementation of federal laws; rules.
Section
743B.120
Section 743B.120
Section
743B.125
Individual health benefit plans; waiting or exclusion periods; preexisting condition exclusions; guaranteed issue and renewal.
Section
743B.126
Carrier marketing of individual health benefit plans; rules; duties of carrier regarding applications; effect of discontinuing offer of plans.
Section
743B.127
Rules for ORS 743.022, 743B.125 and 743B.126.
Section
743B.128
Exceptions to requirement to actively market all plans.
Section
743B.129
Shortening period of exclusion following discontinued offering; rules.
Section
743B.130
Requirement to offer bronze and silver plans; rules.
Section
743B.195
Enforcement of Newborns’ and Mothers’ Health Protection Act of 1996.
Section
743B.197
Health Care Consumer Protection Advisory Committee.
Section
743B.200
Requirements for insurers offering managed health insurance; quality assessment.
Section
743B.202
Requirements for insurers offering managed health or preferred provider organization insurance; rules; opportunity to participate.
Section
743B.204
Required managed health insurance contract provision; enrollee liability.
Section
743B.206
[Formerly 743.831; repealed by 2017 c.101 §53 and 2017 c.384 §13]
Section
743B.220
Requirements for insurers that require designation of participating primary care physician; exceptions.
Section
743B.222
Designation of women’s health care provider as primary care provider; direct access to women’s health care provider.
Section
743B.225
Continuity of care.
Section
743B.227
Referrals to specialists.
Section
743B.250
Required notices to applicants and enrollees; grievances, internal appeals and external reviews.
Section
743B.252
External review; rules.
Section
743B.253
Director to contract with independent review organizations to provide external review; rules.
Section
743B.254
Required statements regarding external reviews.
Section
743B.255
Enrollee application for external review; when enrollee deemed to have exhausted internal appeal.
Section
743B.256
Duties of independent review organizations; expedited reviews.
Section
743B.257
Civil penalty for failure to comply by insurer that agreed to be bound by decision.
Section
743B.258
Private right of action.
Section
743B.260
Claims and appeals of adverse benefit determinations under disability income insurance policies; rules.
Section
743B.280
Definitions for ORS 743B.280 to 743B.285.
Section
743B.281
Estimate of costs for in-network procedure or service.
Section
743B.282
Estimate of costs for out-of-network procedure or service.
Section
743B.283
Submission of methodology used to determine insurer’s allowable charges.
Section
743B.284
Alternative mechanism for disclosure of costs and charges.
Section
743B.285
Rules.
Section
743B.287
Balance billing prohibited for health care facility services.
Section
743B.290
Hospital payment of copayment or deductible for insured patient.
Section
743B.300
Disclosure of differences in replacement health insurance policies; nonduplication for persons 65 and older; rules.
Section
743B.310
Rescinding coverage; permissible bases; notice; rules.
Section
743B.320
Minimum grace period; notice upon termination of policy; effect of failure to notify.
Section
743B.321
Applicability of ORS 743B.320.
Section
743B.323
Separate notice to policyholder required before cancellation of individual or group health insurance policy for nonpayment of premium; rules.
Section
743B.324
Rules for certain notice requirements.
Section
743B.330
Notice to policyholder required for cancellation or nonrenewal of health benefit plan; effect of failure to give notice.
Section
743B.340
When group health insurance policies to continue in effect upon payment of premium by insured individual.
Section
743B.341
Continuation of benefits after termination of group health insurance policy; rules.
Section
743B.342
Continuation of benefits after injury or illness covered by workers’ compensation.
Section
743B.343
Availability of continued coverage under group policy for surviving, divorced or separated spouse 55 or older.
Section
743B.344
Procedure for obtaining continuation of coverage under ORS 743B.343.
Section
743B.345
Premium for continuation of coverage under ORS 743B.344; termination of right to continuation.
Section
743B.347
Continuation of coverage under group policy upon termination of membership in group health insurance policy; applicability of waiting period to rehired employee.
Section
743B.400
Decisions regarding health care facility length of stay, level of care and follow-up care.
Section
743B.403
Insurer prohibited practices; patient communication and referral.
Section
743B.405
Medical services contract provisions; nonprovider party prohibitions; future contracts.
Section
743B.406
Vision care providers.
Section
743B.407
Naturopathic physicians.
Section
743B.420
Prior authorization requirements.
Section
743B.422
Utilization review requirements for medical services contracts to which insurer not party; right to appeal.
Section
743B.423
Utilization review requirements for insurers offering health benefit plan.
Section
743B.424
Applicability.
Section
743B.425
Prior authorization prohibited for first 60 days of treatment for opioid or opiate withdrawal and for post-exposure prophylactic antiretroviral drugs; exceptions.
Section
743B.427
Nonquantitative treatment limitations on coverage of behavioral health conditions.
Section
743B.450
Prompt payment of claims; limits on use of electronic payment methods; rules.
Section
743B.451
Refund of paid claims.
Section
743B.452
Interest on unpaid claims.
Section
743B.453
Underpayment of claims.
Section
743B.454
Claims submitted during credentialing period.
Section
743B.458
Performance-based incentive payments for primary care.
Section
743B.460
Conditions for restricting payments to only in-network providers.
Section
743B.462
Direct payments to providers.
Section
743B.470
Medicaid not considered in coverage eligibility determination; claims for services paid for by medical assistance; prohibited ground for denial of enrollment of child; insurer duties.
Section
743B.475
Guidelines for coordination of benefits; rules.
Section
743B.500
Selling and leasing of provider panels by contracting entity; definitions.
Section
743B.501
Registration of contracting entity.
Section
743B.502
Third party contracts for leasing of provider panels; requirements.
Section
743B.503
Additional requirements for third party contracts.
Section
743B.505
Provider networks; rules.
Section
743B.550
Disclosure of information.
Section
743B.555
Confidential communications.
Section
743B.601
Synchronization of prescription drug refills.
Section
743B.602
Step therapy.
Section
743B.800
Risk adjustment procedures; rules.
Section
743B.810
Enrollees covered by workers’ compensation.